Parálisis facial aislada posterior a infección por virus de chikunguña: un nuevo diagnóstico diferencial / Isolated facial palsy after Chikungunya infection: A novel differential diagnosis

En las últimas décadas, se ha incrementado el reporte de manifestaciones neurológicas asociadas con la infección por el virus de chikunguña. Se informa el caso de un adulto joven previamente sano que presentó parálisis facial izquierda aislada después de una infección reciente por el virus de chikunguña en el trópico colombiano. Se describen aspectos importantes de la fisiopatología del virus y su tropismo por el sistema nervioso central y periférico, y se sugiere considerar este virus en el diagnóstico diferencial de la parálisis facial en pacientes con infección confirmada por el virus de chikunguña en regiones tropicales endémicas o en aquellos con antecedente de viajes recientes a dichas regiones.

A significant raise in the reports of neurological manifestations due to Chikungunya virus has been described worldwide. Here, we describe a case report of a previously healthy young adult who developed isolated left facial palsy after a confirmed Chikungunya virus infection in the Colombian tropics. We suggest considering this virus as a differential diagnosis for facial palsy in patients with confirmed Chikungunya virus infection who live in endemic regions or report a history of recent travel to these regions.

Distribuição espacial de dengue, chikungunya e Zika e os determinantes socioeconômicos em um município da Bahia / Spatial distribution of dengue, chikungunya and Zika and the socioeconomic determinants in a municipality of Bahia

Introdução: desde 1996, o município de Feira de Santana, na Bahia, apresenta sucessivas epidemias de dengue, sendo as mais importantes, do ponto de vista de incidência da doença, as relatadas em 2002 e 2009, com elevados números de casos registrados, hospitalizações e óbitos. Em 2015, houve destaque no registro de casos das três arboviroses, sendo que além da dengue, observase a introdução da chikungunya em 2014 e da Zika em 2015. O índice alto de infestação do Aedes aegypti nas áreas urbana e rural do município pode ter contribuído para a dispersão do vírus. Objetivo: analisar a distribuição espacial da incidência das três arboviroses nas áreas urbana (bairros) e rural (distritos) do município do estudo e avaliar a relação entre os casos das arboviroses e os determinantes socioeconômicos. Metodologia: estudo descritivo realizado em Feira de Santana, no período de 2009 a 2017. Os dados foram distribuídos com auxílio do QGIS por bairros e distritos, apresentados em mapas temáticos. Utilizou-se o programa estatístico Stata versão 14 para análise de dados. Resultados: o estudo mostrou que os bairros localizados na periferia do município e os distritos apresentaram as maiores incidências e as piores condições socioeconômicas, além da co-circulação das três arboviroses na mesma área geográfica e no mesmo período. Conclusão: faz-se necessário ter uma rede de diagnóstico e de vigilância epidemiológica e entomológica consolidada a fim de melhorar o controle destas arboviroses e aprimorar a assistência à saúde.

Introduction: Since 1996, the municipality of Feira de Santana, in Bahia, has presented successive dengue epidemics, the most important, from the point of view of the incidence of the disease, those reported in 2002 and 2009, with high numbers of registered cases, hospitalizations and deaths. In 2015, there was a highlight in the case report of the three arboviruses, and in addition to dengue, there was the introduction of chikungunya in 2014 and Zika in 2015. The high rate of Aedes aegypti infestation in urban and rural areas of the municipality can have contributed to the spread of the virus. Objective: to analyze the spatial distribution of the incidence of the three arboviruses in the urban (neighborhoods) and rural (districts) areas of the municipality of the study and to evaluate the relationship between the cases of arboviruses and the socioeconomic determinants. Methods: a descriptive study carried out in Feira de Santana, from 2009 to 2017. The data were distributed with the aid of QGIS by neighborhoods and districts, presented in thematic maps. The statistical program Stata version 14 was used for data analysis. Results: The study showed that the neighborhoods located on the outskirts of the municipality and the districts had the highest incidences and the worst socioeconomic conditions, in addition to the co-circulation of the three arboviruses in the same geographical area and in the same period. Conclusion: it is necessary to have a consolidated epidemiological and entomological diagnostic and surveillance network in order to improve the control of these arboviruses and improve health care.

Clinical and laboratory study of a newly observed viral infection in the Philippines: A preliminary report

@#Eighteen (18) cases of Chikungunya (or a very close related virus) infection, a newly observed clinical entity in the Philippines, are presented. Diagnosis was established by serological studies consisting of hemagglutination- inhibition (HI) and complement fixation (CF) tests. The clinical picture is characterized by a symptom-complex consisting essentially of fever, severe, incapacitating, recurrent joint pains and a rash. There is no involvement of the respiratory system and no bleeding tendencies were observed. The erythrocyte sedimentation rate was elevated, more so towards the later part of the illness. The platelet counts were normal. No residual joint deformity morbidity or mortality was encountered.

Comunicação na prevenção e controle de dengue, chikungunya e Zika: um panorama analisado junto à população brasileira / Communication in prevention and control to dengue, chikungunya, and zika: a panorama analyzed with the brazilian population / Comunicación en la prevención y control del dengue, chikungunya y zika: un panorama analizado con la población brasileña

Objetivo: Compreender a comunicação na prevenção de arboviroses no Brasil por meio da análise da percepção de comunidades de 17 municípios das cinco regiões brasileiras sobre as campanhas audiovisuais veiculadas pelo Ministério da Saúde sobre dengue, chikungunya e Zika no período de 2014 a 2018. Método: Pesquisa qualitativa, que articula as pesquisas bibliográfica, documental e ação. Associando-se à pesquisa-ação a participação coletiva de debate entre os sujeitos, que se expressam, escutam seus pares e a si mesmos por meio do exercício reflexivo. Adotou-se a análise de conteúdo temática. Os diálogos gravados, foram transcritos, categorizados e interpretados. Resultados: Emergiram as seguintes categorias de análise: Forma de acesso ao conteúdo das campanhas de comunicação; Natureza estética das mensagens analisadas; Identificação com o público, situações e mensagens das campanhas; e, Avaliação da qualidade do material no cumprimento de seus objetivos. Conclusões: Observou-se a necessidade de descentralizar ações de comunicação, investindo em estratégias interpessoais e comunitárias considerando contextos locais. Considera-se que o alerta de perigo é importante em situações de riscos, mas faltam habilidades aos comunicadores envolvidos. A população entende que campanhas direcionadas são mais efetivas, todavia demanda estratégias mais informativas e educativas para prevenção de arboviroses. (AU)

Objective: To understand communication in the prevention of arboviruses in Brazil through the analysis of the perception of communities in 17 municipalities in the five Brazilian regions about the audiovisual campaigns carried out by the Ministry of Health on dengue, chikungunya and Zika in the period from 2014 to 2018. Methods: Qualitative research, which articulates bibliographic, documentary and action research. The collective participation in the debate between the subjects, who express themselves, listen to their peers and themselves through a reflective exercise, is associated with action research. Thematic content analysis was adopted. The recorded dialogues were transcribed, categorized and interpreted. Results: The following categories of analysis emerged: form of access to the content of communication campaigns; a esthetic nature of the analyzed messages; identification with the public, situations and campaign messages; and evaluation of the quality of the material in the fulfillment of its objectives. Conclusion: There was a need to decentralize communication actions, investing in interpersonal and community strategies considering local contexts. Danger alert is considered important in risky situations, but the involved communicators lack skills. The population understands that targeted campaigns are more effective, but they demand more informative and educational strategies for preventing arboviruses. (AU)

Objetivo: Comprender la comunicación en la prevención de arbovirus en Brasil a través del análisis de la percepción de las comunidades de 17 municipios de las cinco regiones brasileñas sobre las campañas audiovisuales realizadas por el Ministerio de Salud sobre dengue, chikungunya y Zika en el período de 2014. al 2018. Métodos: Investigación cualitativa, que articula la investigación bibliográfica, documental y acción. La participación colectiva en el debate entre los sujetos, que se expresan, escuchan a sus pares y a sí mismos a través de un ejercicio reflexivo, está asociada a la investigación acción. Se adoptó el análisis de contenido temático. Los diálogos grabados fueron transcritos, categorizados e interpretados. Resultados: Surgieron las siguientes categorías de análisis: forma de acceso al contenido de las campañas de comunicación; naturaleza estética de los mensajes analizados; identificación con el público, situaciones y mensajes de campaña; y evaluación de la calidad del material en el cumplimiento de sus objetivos. Conclusion: Existía la necesidad de descentralizar las acciones de comunicación, invirtiendo en estrategias interpersonales y comunitarias considerando los contextos locales. La alerta de peligro se considera importante en situaciones de riesgo, pero los comunicadores involucrados carecen de habilidades. La población entiende que las campañas dirigidas son más efectivas, pero demandan estrategias más informativas y educativas para prevenir los arbovirus. (AU)

Reconociendo el virus del chikunguña / Rediscovering the chikungunya virus

Resumen | El virus de chikunguña (CHIKV) es un Alfavirus perteneciente al grupo denominado del Viejo Mundo; estos son virus artritogénicos que causan una enfermedad febril caracterizada por artralgias y mialgias. Aunque la muerte por CHIKV es poco frecuente, la enfermedad puede llegar a ser incapacitante y generar un amplio espectro de manifestaciones atípicas, como complicaciones cardiovasculares, respiratorias, oculares, renales y dérmicas, entre otras. Cuando el dolor articular persiste por tres o más meses, da lugar a la forma crónica de la enfermedad denominada reumatismo inflamatorio crónico poschikunguña, el cual es la principal secuela de la enfermedad. Se considera que este virus no es neurotrópico, sin embargo, puede afectar el sistema nervioso central y generar secuelas graves y permanentes, principalmente, en niños y ancianos. En África, Asia y Europa se habían reportado anteriormente brotes epidémicos por CHIKV, pero solo hasta finales del 2013 se documentó la introducción del virus a las Américas; desde entonces, el virus se ha propagado a 45 países o territorios del continente y el número de casos acumulados ascendió a cerca de dos millones en dos años. Esta revisión describe de manera general la biología molecular del virus, sus manifestaciones clínicas, su patogénesis y las principales complicaciones posteriores a la infección. Además, reúne la información de la epidemia en Colombia y el continente americano publicada entre el 2014 y el 2020.

Abstract | The chikungunya virus (CHIKV) is an Alphavirus that belongs to the Old World group. These arthritogenic viruses cause a febrile illness characterized by arthralgias and myalgias. Although fatal cases during CHIKV infection are rare, the disease may be disabling and generate a broad spectrum of atypical manifestations, such as cardiovascular, respiratory, eye, kidney, and skin complications, among others. When joint pain persists for three or more months, it results in the chronic form of the disease called post-chikungunya chronic inflammatory rheumatism, which constitutes the main disease sequel. CHIKV is not considered a neurotropic virus; however, it can affect the central nervous system, especially in children and the elderly, causing severe and permanent sequelae. CHIKV outbreaks had been previously reported in Africa, Asia, and Europe, but the virus introduction to the American continent was documented until the end of 2013. Since then, the virus has spread to 45 countries and territories causing near two million cases in just two years. This review describes the molecular biology, clinical manifestations, pathogenesis, and significant post-infection complications of CHIKV. Additionally, it collects published information about the outbreak in Colombia and the American continent between 2014 and 2020.

Arbovirus en Uruguay, un problema potencial. Revisión desde una óptica perinatal / Arbovirus in Uruguay, a potential problem. Review from a perinatal perspective / Arbovírus no Uruguai, um problema potencial. Revisão a partir de uma perspectiva perinatal

Resumen: Los arbovirus son microorganismos transmitidos al ser humano por artrópodos. Existen más de 100 tipos de arbovirus, con una presentación clínica común para todos ellos de fiebre, síntomas articulares, hemorrágicos y neurológicos1. Además, representan un riesgo particular para la mujer embarazada y el feto por el potencial teratogénico que algunos de ellos presentan, particularmente a nivel del sistema nervioso central. Utilizando los motores de búsqueda de Pubmed y de Google Scholar, realizamos una búsqueda bibliográfica enfocada a los arbovirus en general y luego enfocada en cada una de las patologías específicas abordadas, que fueron definidas en función del riesgo de ingreso a nuestro país y sus potenciales consecuencias. El objetivo de esta revisión es analizar las principales características de presentación de los arbovirus, en particular dengue, zika, chikungunya y fiebre amarilla ante la eventualidad de la aparición de casos de transmisión vertical, para que nuestros recursos humanos especializados tengan un marco de referencia del manejo actualizado. Esta revisión nos permitió concluir sobre los elementos comunes de estas virosis, así como sus potenciales afectaciones en el feto y en el recién nacido, y nos planteó el desafío vinculado a su dificultad diagnóstica por las reacciones cruzadas.

Summary: Arbovirus are microorganisms transmitted to humans through arthropods. There are more than 100 different arboviruses with a common clinical presentation of fever, articular, hemorrhagic and neurological symptoms1. They represent a mayor risk to pregnant women and fetuses due to their teratogenic effect, particularly affecting the central nervous system. We performed a specific search focused on arbovirus using search engines Pubmed and Google Scholar and we classified evidence according to the risk of a certain virus entering our country and its potential consequences. The objective of this review is to update the main clinical characteristics of arbovirus, particularly Dengue, Zika, Chikungunya and Yellow Fever particularly due to the potential introduction of these viruses in our country and the possibility of vertical transmission, so that our human resources have a guide on how to approach these patients nowadays. This review allowed us to conclude on common characteristics of these viruses, their possible consequences on fetus and newborns, and concluding on the difficulty of etiological diagnosis due to cross reactions.

Resumo: Os arbovírus são microrganismos transmitidos ao homem por artrópodes. Existem mais de 100 tipos de arbovírus, com apresentação clínica comum a todos eles de febre, sintomas articulares, hemorrágicos e neurológicos1. Além disso, representam um risco particular para a gestante e para o feto devido ao potencial teratogênico que alguns deles apresentam, principalmente ao nível do sistema nervoso central. Realizamos uma busca bibliográfica utilizando Pubmed e Google Scholar sobre arbovírus em geral e posteriormente, sobre cada uma das patologias específicas abordadas que foram definidas de acordo com o risco de entrada em nosso país e suas possíveis consequências. O objetivo desta revisão é analisar as principais características de apresentação dos arbovírus, em particular dengue, Zika, Chikungunya e febre amarela, considerando a possibilidade de casos de transmissão vertical, para servir como uma referência atualizada para os profissionais especializados nesta área. Esta revisão permitiu elaborar conclusões sobre os elementos comuns a esses vírus, bem como suas possíveis afetações no feto e no recém-nascido, e apresentou o desafio relacionado à dificuldade diagnóstica devido às reações cruzadas.

Detecção de arboviroses em gestantes na região noroeste do Estado de São Paulo / Detection of arboviroses in pregnant women in the northwest region of the state of São Paulo

As infecções ocasionadas pelos vírus da Dengue (DENV), Zika (ZIKV) e Chikungunya (CHIKV) em gestantes são de grande preocupação pelos possíveis danos causados pelos mesmos às mães e fetos. O ZIKV está relacionado à microcefalia e outras anomalias cerebrais graves em neonatos e a infecção por CHIKV em gestantes no período intraparto pode levar à transmissão vertical, com possibilidade de agravamento no quadro do neonato. E, apesar de ainda não haver relatos de ocorrência de malformações congênitas associadas à infecção por DENV em gestantes, as mesmas são consideradas um grupo de risco, pois apresentam maiores chances de evolução para formas graves ou óbito e aumento no risco de partos prematuros decorrente da infecção materna perinatal. Neste estudo, foi realizada uma análise retrospectiva dos resultados envolvendo os vírus DENV, ZIKV e CHIKV para determinar a taxa de positividade destas arboviroses em gestantes no município de São José do Rio Preto-SP, nos anos de 2018 e 2019. Para isso, foram coletados resultados de PCR em tempo real (RT-PCR) para DENV, ZIKV e CHIKV de amostras de soro e urina obtidas de 557 gestantes com histórico de febre, bem como 93 amostras de recém-nascidos (RN). Na análise dos resultados foi verificado que o sorotipo-2 de Dengue (DENV-2) foi detectado em 106/557 correspondendo a 19% das amostras, o sorotipo-1 (DENV-1) foi detectado em apenas uma amostra e o ZIKV foi detectado em duas amostras. CHIKV não foi detectado. Não foi detectado arbovírus nas amostras de RN testadas pela técnica de RT-PCR. Quanto à idade, 40% das gestantes pertenciam à faixa etária de 25 a 32 anos, seguidas pelas faixas de 33 a 40 anos e 17 a 24 anos com percentuais de 31 e 29%, respectivamente. No período, uma gestante que estava na 13ª semana de gestação foi a óbito por DENV-2. Os resultados obtidos evidenciam a importância do diagnóstico precoce das arboviroses neste grupo, viabilizando a assistência adequada às gestantes. Nesse sentido, o monitoramento da circulação simultânea de arboviroses responsáveis por causarem complicações em gestantes e infecções congênitas deve continuar em áreas endêmicas como a de São José do Rio Preto, visando um diagnóstico materno precoce e manejo adequado de gestantes testadas positivas verificando a presença de sinais de alerta e de dengue grave.

Infections caused by Dengue (DENV), Zika (ZIKV) and Chikungunya (CHIKV) viruses in pregnant women represent great concern because of the possible damage that can be caused by these viruses to both mothers and fetuses. ZIKV is related to microcephaly and other severe brain abnormalities in neonates, while CHIKV infection in pregnant women in the intrapartum period can lead to vertical transmission, with the possibility of worsening in the neonate. And although there are no reports of congenital malformations associated with DENV infection in pregnant women, they are also considered of risk group, since they have greater probability to progress to severe forms or even death. In addition, there is an increased risk of premature childbirth. In this study, a retrospective result analysis involving DENV, ZIKV and CHIKV viruses was carried out to determine the positivity rate of those arboviruses in pregnant women in the city of São José do Rio Preto-SP, in the years 2018 and 2019. For this purpose, real-time PCR results (RT-PCR) were collected for DENV, ZIKV and CHIKV from serum and urine samples obtained from 557 pregnant women with a history of fever, as well as samples from 93 newborns (NB). Dengue serotype-2 (DENV-2) was detected in 106/557, which corresponds to 19% of the samples; dengue serotype-1 (DENV-1) was detected in only one sample, and the ZIKV was detected in two samples. CHIKV was not detected. Arboviruses were not detected in the NB samples tested by the RT-PCR technique. In relation to age groups, 40% of pregnant women were between 25 to 32 years old, followed by the groups of 33 to 40 years old, and 17 to 24 years old, with 31% and 29%, respectively. In the period, a pregnant woman who was in the 13th week of pregnancy died due to DENV-2. The results obtained emphasize the importance of the early diagnosis of arboviruses in this group, thus enabling adequate assistance to pregnant women. In this sense, the monitoring of arboviruses circulation responsible for causing complications and congenital infections in pregnant women should continue in endemic areas such as São José do Rio Preto, aiming at an early maternal diagnosis and adequate management of the patients who tested positive, checking for the presence of any alert signs and severe dengue.

O uso de uma plataforma virtual para mobilização social no enfrentamento de arboviroses e controle do Aedes aegypti / The use of a virtual platform for social mobilization in the confrontation of arboviruses and control of Aedes aegypti / El uso de una plataforma virtual para la movilización social para combatir los arbovirus y el control de Aedes aegypti

A mobilização social para o enfrentamento da dengue, zika, chikungunya e controle do Aedes aegypti tem sido um desafio no país. Esse artigo apresenta o processo de elaboração de uma plataforma virtual, incluindo a composição do seu acervo e a análise exploratória do seu uso, como ferramenta, numa proposta de mobilização social que envolve a criação de comitês populares nos territórios para o enfrentamento das três doenças e vetor. A construção da plataforma considerou: facilidade para usuário; acesso; armazenamento de material; interatividade e banco para monitoramento de dados. A seleção do acervo baseou-se em critérios: técnico, referente à fonte e autoria; acurácia, concordância entre informação e evidência em saúde; e legibilidade, garantindo a compreensão por diferentes grupos. A análise exploratória utilizou o banco de dados da plataforma. Os resultados apontaram a plataforma como uma ferramenta que pode contribuir com a comunicação e informação em saúde nessa proposta de mobilização social.

Social mobilization for dengue, zika and chikungunya prevention and control of Aedes aegypti has been a challenge in the country. This paper presents the process of elaboration of a virtual platform, including the composition of its collection and the exploratory analysis of its use, as a tool in a social mobilization proposal that encompasses the creation of popular committees in the territories for the confrontation of the three diseases and vector. The construction of the platform considered: ease of use; access; material storage; interactivity and database for data monitoring. The selection of the collection was based on the following criteria: technical, considering source and authorship; accuracy, regarding the agreement between health information and evidence; legibility, ensuring the understanding by different groups. The exploratory analysis used the platform database. The results showed the platform as a tool which can contribute to health communication and information in this proposal of social mobilization.

La movilización social para combatir el dengue, zika, chikungunya y control de Aedes ha sido un desafío. Este artículo presenta el proceso de elaboración de una plataforma virtual, que incluye la composición de su acervo y el análisis exploratorio de su uso, como herramienta en una propuesta de movilización social que implica la creación de comités populares en los territorios para enfrentar las enfermedades y el vector. La construcción de la plataforma consideró: facilidad para usuario; acceso; almacenamiento de material; interactividad y bases de datos para el monitoreo. La selección del acervo se basó en criterios: técnico, con fuente y autoría; precisión, concordancia entre información y evidencia en salud; legibilidad, para garantizar la comprensión por diferentes grupos. El análisis utilizó datos de la plataforma. Los resultados mostraron que la plataforma puede ser una herramienta para contribuir a la comunicación e información de salud en esta propuesta de movilización social.

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Abstract INTRODUCTION: Cerebrospinal fluid analysis contributes to the diagnosis and neuropathogenesis of neuroinvasive arboviruses. Neurological complications caused by dengue, Zika, and chikungunya infections have high clinical relevance because of their high potential to cause death or neurological deficits. We aimed to evaluate the use of cerebrospinal fluid assays for diagnostic support in neurological disorders associated with dengue, chikungunya, and Zika infections. METHODS: A systematic review was carried out by searching the electronic databases LILACS, PubMed, Scopus, and Embase for articles written in English, Portuguese, or Spanish in the last 19 years. Published studies were reviewed using the terms "dengue," "Zika", "chikungunya", alone or in combination with "cerebrospinal fluid" in the period from 2000 to 2019. RESULTS: A total of 98,060 studies were identified; of these, 1.1% (1,041 studies, 58,478 cases) used cerebrospinal fluid assays for neurological investigations. The most frequent neurological disorders included encephalitis (41.4%), congenital syndromes (17%), and microcephaly associated with Zika virus infections (8.9%). Neuroinvasive disorders were confirmed in 8.03% of 58,478 cases by specific cerebrospinal fluid analyses. The main methods used were IgM-specific antibodies (66%) and reverse transcription-polymerase chain reaction (10%). The largest number of scientific papers (29%) originated from Brazil, followed by India (18.4%) and the United States (14.4%). CONCLUSIONS: Although cerebrospinal fluid analysis is of great importance for increasing neurological diagnostic accuracy and contributes to the early diagnosis of neuroinvasive dengue, chikungunya, and Zika infections, it is underused in routine laboratory investigations worldwide.

Caracterização sociodemográfica e clinica dos casos de dengue, chikungunya e zika no Rio Grande Do Norte, Brasil - 2015-2017 / Sociodemographic and clinical profile of dengue, chikungunya, and zika in Rio Grande do Norte state, Brazil ­ 2015-2017

Objetivo: Caracterizar o perfil sociodemográfico e clínico das arboviroses Dengue, Chikungunya e Zika no estado do Rio Grande do Norte, Brasil, entre 2015 e 2017.Método:Trata-se de um estudo epidemiológico descritivo. A população constitui-se dos casos con-firmados das arboviroses Dengue, Chikungunya e Zika de 2015 a 2017. Foi utilizado como fonte para extração dos dados do estudo o Sistema de Informação de Agravos de Notifica-ção da Secretaria de Estado da Saúde Pública do Rio Grande do Norte. Esses dados foram tabulados e exportados para o Excel® 2016. Resultados: Houve 30.776 casos de Dengue, 9.151 de Chikungunya e 260 de Zika, os quais apresentaram sintomas clássicos como febre (84,28%), cefaleia (71,68%) mialgia (67,6%). Contudo, poucas amostras de exames labo-ratoriais foram realizadas para a confirmação desses agravos. Conclusão: Os achados do estudo demonstram uma situação desafiadora para a saúde pública do Rio Grande do Norte na tentativa de combater e minimizar os efeitos desses agravos.

Objective:Characterize the sociodemographic and clinical profile of Dengue, Chikun-gunya, and Zika arboviruses in the state of Rio Grande do Norte from 2015 to 2017. Meth-od: This is a descriptive epidemiological study. The population consists of confirmed cases of Dengue, Chikungunya, and Zika arboviruses from 2015 to 2017. We used the Informa-tion System for Notifiable Diseases of the State Secretariat of Public Health of Rio Grande do Norte to extract the study data, which were tabulated and exported to Excel® 2016. Re-sults: There were 30,776 cases of Dengue, 9,151 of Chikungunya, and 260 of Zika, with classic symptoms such as fever (84.28%), headache (71.68%) myalgia (67.6%). There were few samples of laboratory tests to confirm these problems, though. Conclusion: The findings demonstrate a challenging situation for public health in Rio Grande do Norte, an attempt to combat and minimize the effects of these injuries.

Long-Term Persistence of Serum-Specific Anti-Chikungunya IgM Antibody - A Case Series of Brazilian Patients

Abstract The persistence of serum-specific anti-chikungunya IgM antibodies (CHIKV-IgM) can vary after chikungunya fever (CHIK) infection. However, the factors related to its production are not yet known. We described a case series drawn up from data collected from 57 patients between 12 and 36 months after the acute phase of CHIK infection in Northeastern Brazil. CHIKV-IgM was detectable in 7/57 (12.3%) patients after 28.3 months of infection. No frequency differences in chronic musculoskeletal manifestations and underlying conditions were detected between patients with or without CHIKV-IgM. CHIKV-IgM was detected for up to 35 months in Brazilian patients after CHIK infection.

Analytical and clinical performance of molecular assay used by the Brazilian public laboratory network to detect and discriminate Zika, Dengue and Chikungunya viruses in blood

ABSTRACT In response to the Zika epidemics in Brazil, the ZDC molecular assay (Bio-Manguinhos) was developed and registered at the Brazilian Regulatory Agency of Health Surveillance - ANVISA. The circulation of Zika (ZIKV) Dengue (DENV) and Chikungunya (CHIKV) viruses and their clinical similarities are challenges to correctly diagnose these viruses. The simultaneous detection of ZIKV, DENV and CHIKV is an important tool for diagnosis and surveillance. Here, we present the analytical and clinical performance evaluation of ZDC molecular assay (Bio-Manguinhos) at the public health laboratories three years after its registration at ANVISA. The clinical performance demonstrates the ZDC molecular assay (Bio-Manguinhos) has 100% sensitivity and 100% specificity to detect and discriminate ZIKV, CHIKV, and DENV from clinical plasma samples. The ZDC molecular assay (Bio-Manguinhos) results were highly reproducible and no cross-reactivity was seen during testing with a panel of other infectious agents. In conclusion, the ZDC molecular assay (Bio-Manguinhos) is an accurate and reliable tool to monitor Zika, dengue and chikungunya infections in countries like Brazil with simultaneous circulation of the three viruses.

Caracterização de pacientes com sequelas após infecção pelo vírus chikungunya de acordo com a CIF / Characterization of patients with sequelae after chikungunya virus infection according to the ICF

Objetivo: caracterizar segundo a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), as sequelas apresentadas por pacientes após infecção pelo vírus chikungunya (CHIKV). Metodologia: estudo transversal e descritivo, realizado com 34 participantes, com diagnóstico sorológico e/ou clínico de infecção pelo CHIKV. As variáveis foram coletadas por meio da Escala Visual Analógica (EVA), Short Form Health Survey 36 (SF-36) e Medical Research Council (MRC), e relacionadas com os domínios da CIF para então classificá-las. Os dados foram tabulados em planilha Microsoft Excel 2013 com estatística descritiva calculada pelo programa GraphPad Prism 6. Os resultados foram apresentados como média e desvio padrão ou mediana e intervalo interquartil. Resultados: os resultados obtidos com a EVA foram caracterizados como moderada a grave deficiência, no SF-36 os domínios variaram de moderada a completa deficiência e no MRC todos os movimentos analisados corresponderam a ligeira deficiência. Conclusão: foi possível caracterizar alterações osteomioarticulares e a funcionalidade dos pacientes infectados pelo CHIKV e classificá-los dentro do contexto da CIF, garantindo uma padronização para a descrição dos componentes relacionados à saúde desses pacientes.

Objective: This study aimed to characterize the sequelae presented by patients after chikungunya virus (CHIKV) infection, using the International Classification of Functioning, Disability and Health (ICF). Methodology: Was made a descriptive cross-sectional study with 34 subjects with a serological and / or clinical diagnosis of CHIKV infection. The data were collected using the Visual Analogue Scale (VAS), Short Form Health Survey 36 (SF-36) and Medical Research Council (MRC), and were related and classified by the ICF domains. Data were arranged in Microsoft Excel 2013 and descriptive statistics was performed. Results were presented as mean and standard deviation or median and interquartile range. Results: VAS values were characterized from moderate to severe deficiency, SF-36 results showed the domains ranged from moderate to complete deficiency and in MRC data all movements analyzed were mild deficient. Conclusion: It was possible to characterize osteomioarticular changes and the functionality of CHIKV infected patients and to classify them within the context of the ICF, ensuring standardization for the description of health-related components of these patients.

Clinical and laboratory findings of acute Zika virus infection in patients from Salvador during the first Brazilian epidemic

Abstract Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.

Nebulización térmica intradomiciliar de la mezcla de flupyradifurona y transflutrina en mosquitos Aedes aegypti susceptibles y resistentes a piretroides en el Sur de México / Indoor thermal fogging of the mixture of flupyradifurone and transflutrin on Aedes aegypti mosquitoes susceptible and resistant to pyrethroids in southern Mexico

Resumen: Objetivo: Evaluar la efectividad de la mezcla de flupyradifurona 26.3 g/L y transflutrina 52.5 g/L aplicada como niebla térmica a mosquitos Aedes vectores de virus dengue, Zika y chikungunya. Material y métodos: Se colocaron grupos de 15 mosquitos de Ae. aegypti (susceptibles y resistentes a piretroides) dentro de jaulas, en sala, recámara y cocina. Posteriormente, se aplicó la mezcla de flupyradifurona y transflutrina dentro de las viviendas a una dosis de 2 y 4 mg/m3, respectivamente. Resultados: La mezcla de flupyradifurona y transflutrina causó mortalidades de 97 a 100% sobre las cepas de mosquitos Aedes y su efectividad fue la misma en los diferentes compartimentos de las viviendas. Conclusiones: La mezcla de flupyradifurona y transflutrina, aplicada en niebla térmica, es una herramienta prometedora para el control de poblaciones de mosquitos Aedes independientemente de su estado de resistencia a insecticidas.

Abstract: Objective: To evaluate the efficacy of thermal fogging of a mixture of flupyrafirudone (26.3 g/L) and transfluthrin (52.5 g/L) against dengue, Zika y chikungunya Aedes mosquito vectors. Materials and methods: Groups of 15 caged Ae. aegypti (susceptible and pyrethroid resistant) mosquitoes were placed in living room, kitchen and bedroom inside houses, after which a dose of 2 and 4 mg/m3 of flupyradifurone and transfluthrine, respectively, was applied as thermal fog. After one hour of exposure mosquitoes were transferred to the laboratory and mortality was recorded after 24 h. Results: The mixture killed 97 to 100% of mosquitoes from the strains and the efficacy was similar independently of their place within the premises. Conclusions: The mixture of flupyrafirudone and transfluthrin applied as thermal fog is a promising tool to control Aedes mosquito populations independently of the pyrethroid-insecticide resistance status.

Producción de plásmidos recombinantes para su uso como controles de la técnica RT-PCR para el diagnósticode los virus Chikungunya y Zika / Production of recombinant plasmids as controls of diagnosis technique (RTPCR) of Chikungunya and Zika viruses

El diagnóstico molecular de arbovirus es indispensable para identificar agentes etiológicos, particularmente en zonas endémicas para al menos uno de ellos. Estas deben ser validadas con controles positivos, los cuales están clásicamente representados por virus vivos, cuya obtención puede ser riesgosa, laboriosa y costosa. El objetivo de este estudio fue producir plásmidos recombinantes para su uso como controles positivos en la validación de la técnica RT-PCR para el diagnóstico de los virus Chikungunya (CHIKV) y Zika (ZIKV). A partir de los ARN extraídos de los virus [CHIKV (LARD809-GC) y ZIKV (MR766)] se obtuvieron por RT-PCR fragmentos parciales de ADN correspondientes a secuencias nucleotídicas de los genes E1 y NS5 de los virus Chikungunya y Zika, respectivamente, para serclonados en el plásmido comercial pGEM®-T Easy. La clonación se confirmó mediante PCR de colonias y PCR de ADN plasmídicos extraídos a partir de las colonias recombinantes. Se logró la producción de dos plásmidos recombinantes CHIKV-E1/pGEM®-T Easy y ZIKV-NS5192/pGEM®-T Easy con cada una de las secuencias especificadas, para su uso en la validación y control de las técnicas moleculares descritas en este reporte, para el diagnóstico de agentes virales CHIKV y ZIKV, evitando la manipulación de cultivos celulares y garantizando una fuente confiable de controles positivos(AU)

The use of molecular techniques for the viral diagnosis requires the use of positive controls.Classically, the controls are live viruses, whose manipulation may be risky, laborious and expensive. The objective of this study was produced recombinant plasmids to obtain cloned sequences of Chikungunya (CHIKV) and Zika (ZIKV) virus for their use as controls in the specificdiagnostic by RT-PCR. DNA fragments were obtained fromRNA [CHIKV (LARD809-GC) and ZIKV (MR766)] using specific primers to amplify the nucleotide sequences from fragments of Envelope 1 protein (E1) of CHIKV and Non Structural 5 protein (NS5) of ZIKV genomes. The 548 bp (CHIKV) and 192 bp(ZIKV) bands were purified from agarose gel and ligations were performed with the cloning vector pGEM®-T Easy. The Escherichia coli XL1-Blue MRF` cells were transformed with the ligation mixture, the recombinant colonies were identified by colony PCR using the specific primers to the specific viral agent. One recombinant colony from CHIKV and six recombinant colonies from ZIKV were obtained from which plasmidic DNAs was extracted. The plasmidic DNAs were used as reaction controls in CHIKV and ZIKV RT-PCR, obtaining the characteristic bands. The cloning of the sequences was successful to produce the recombinant plasmids (CHIKV-E1/pGEM®-T Easy y ZIKV-NS5192/pGEM®-T Easy) to use in the validation of RT-PCR techniques(AU)

O que pensam os agentes comunitários de saúde (ACS) e os agentes de combate às endemias (ACE) de João Pessoa-PB sobre os cartazes de dengue, zika e chikungunya veiculados pelo Ministério da Saúde (2013-2017)? / What do community health agents (ACS) and endemic combat agents (ACE) of João Pessoa-PB think about the dengue, zika chikungunya posters released by the Ministry of Heath (2013-2017)? / ¿Qué piensan los agentes comunitarios de salud (ACS) y los agentes de combate a las endemias (ACE) de João Pessoa-PB sobre los carteles de dengue, zika y chikungunya vehiculados por el Ministerio de Salud (2013-2017)?

Dengue, zika e chikungunya são arboviroses recorrentes no contexto urbano brasileiro. O ano de 2016 foiepidêmico para as três doenças. Os agentes comunitários de saúde (ACS) e os agentes de combate às endemias (ACE) exercem papel fundamental para a prevenção e o controle dessas doenças, e a comunicação em saúde faz parte do trabalho desses profissionais, subsidiando a tomada de decisão da comunidade. A pesquisa teve como objetivo conhecer a percepção dos ACS e ACE sobre os cartazes veiculados pelo Ministério da Saúde em relação às arboviroses pesquisadas.A pesquisa foi realizada no município de João Pessoa-PB, e os dados qualitativos foram obtidos por meio de entrevistas semiestruturadas; a pergunta norteadora sobre os cartazes selecionados foi analisada por meio do Discurso do Sujeito Coletivo (DSC).Entre os sete ACS e quatro ACE entrevistados, foram identificadas cinquenta expressões-chave, que foram distribuídas nas quatro ideias centrais, geradoras dos discursos-síntese:(1) trabalho informativo; (2) adequação dos conteúdos; (3) dificuldades; e (4) comunicação e mobilização. Este trabalho evidenciou uma breve avaliação dos ACS e ACE sobre uma amostra de cartazes sobre dengue, zika e chikungunya no município de João Pessoa-PB. Quanto ao trabalho dos agentes com os materiais impressos,puderam-se observar pontos positivos e negativos em relação à comunicação para a promoção da saúde por meio desses materiais. (AU)

Dengue, zika and chikungunya are recurrent arboviruses in the Brazilian urban con-text. The year 2016 was an epidemic year for the three diseases. Community health agents(ACS) andendemic combat agents (ACE) play a key role in the prevention and control of these diseases, and health communication is part of the work of these professionals,subsidizing community deci-sion-making. The objective of the research was to know the perception of the ACS and ACE on the posters published by the Ministry of Health in relation to the arboviruses researched.The research was carried out in the municipality of João Pessoa-PB, and qualitative data were obtained through semi-structured interviews; the guiding question about the selected posters was analyzed through the Collective Subject Discourse.Fifty key expressions were identified amonginterviews of seven ACS and fourACE, which were distributed in the four central ideas that generated the synthesis speeches: (1) informative work; (2) content suitability; (3) difficulties; and (4) communication and mobilization.This work evidenced a brief evaluation of ACS and ACE on a sample of posters about dengue, zika and chikungunya in the municipality of João Pessoa-PB. Regarding the work of the agents with the printed materials, one can observe positive and negative points in relation to com-munication for health promotion through such materials. (AU)

Dengue, zika y chikungunya son arbovirosis recurrentes en el contexto urbano brasileño. El año 2016 fue un año epidémico para las tres enfermedades. Los agentes comunitarios de salud (ACS) y los agentes de combate a las endemias (ACE) desempeñan un papel fundamental para la prevención y control de estas enfermedades, y la comunicación en salud forma parte del trabajo de estos profesionales, subsidiando la toma de decisión de la comunidad. La investigación tuvo como objetivo conocer la percepción de los ACS y ACE sobre los carteles vehiculados por el Ministerio de Salud en relación a las arbovirosis investigadas. La investigación fue realizada en la ciudad de João Pessoa-PB, y los datos cualitativos fueron obtenidos por medio de entrevistas semiestructuradas; la pregunta orientadora sobre los carteles seleccionados fue analizada por medio del Discurso del Sujeto Colectivo (DSC). Entre los siete ACS y cuatro ACE entrevistados, se identificaron cincuenta expresiones clave, que se distribuyeron en las cuatro ideas centrales, generadoras de los discursos-síntesis: (1) trabajo informativo; (2) adecuación de los contenidos; (3) dificultades; y (4) comunicación y movilización. Este trabajo evidenció una breve evaluación de los ACS y ACE sobre una muestra de carteles sobre dengue, zika y chikungunya en el municipio de João Pessoa-PB. Con respecto al trabajo de los agentes con los materiales impresos, se pueden observar puntos positivos y negativos en relación a la comunicación para la promoción de la salud por medio de los estos materiales. (AU)

Avaliação da armadilha ovitrampa iscada com atraente natural para o monitoramento de Aedes spp. em Dili, capital do Timor-Leste / Evaluation of the baited ovitrap with natural attractant for monitoring Aedes spp. in Dili, capital of East Timor

Resumo A dengue ocorre no Timor-Leste desde 2005, porém não existe um programa de monitoramento e controle do "Aedes aegypti". O objetivo deste estudo foi de avaliar a armadilha ovitrampa iscada com atraente natural como uma possível ferramenta para monitorar o vetor das arboviroses: Dengue (DENV), Chikungunya (CHIKV) e Zika (ZIKV). O estudo foi realizado na cidade de Dili, capital do Timor-Leste, entre as semanas epidemiológicas 32 (02/08) a 48 (02/12) de 2016. Foram instaladas 70 armadilhas Ovitrampa, em residências de 15 sucos (ruas), de quatro Postos Administrativos (bairros) da cidade. Para as analises dos dados utilizou-se os indicadores entomológicos: Índice de Positividade de Ovitrampa (IPO), Índice de Densidade Vetorial (IDV) e Índice de Densidade de Ovos (IDO). Durante o experimento foram coletados 158.904 ovos de Aedes spp.. O IPO demonstrou que todas as áreas tiveram 98% a 100% de armadilhas contendo ovos de Aedes spp.. Os indicadores IDO e IPO apresentaram correlações positivas e significativa com a temperatura. A defasagem de duas e três semanas para precipitação indicou correlação positiva significativa para IDV e IDO. Portanto, a armadilha ovitrampa é uma ferramenta que pode integrar as ações de um programa de monitoramento e controle de Aedes spp. no Timor-Leste.

Seroprevalence of chikungunya virus infection in five hospitals within Anyigba, Kogi State of Nigeria

ABSTRACT Febrile illnesses in developing countries are often misdiagnosed as malaria or typhoid fever. Although arboviral infections have similar clinical symptoms, they are usually not screened because of limited resources and the fact that there are several viruses in this group. Chikungunya virus (CHIKV) has been isolated in parts of Nigeria, but there is no documented evidence of the infection in Kogi State. This study determined seroprevalence of active and past CHIKV infection among febrile patients who tested negative for malaria and typhoid fever. Sera from 243 febrile patients were screened for CHIKV IgG and IgM using an immunochromatographic test kit. Clinical and socio-demographic variables were collected using a structured questionnaire. Recent CHIKV infection was observed in 5.8% of the study participants while 25.1% had IgG antibodies demonstrating previous infection. Significant associations were observed between seropositivity and age of participants (p < 0.001), sex (p = 0.044), marital status (p = 0.002), and occupation (p < 0.001). Clinical symptoms such as fever, joint pain, and headache were significantly associated with seropositivity. This study identified recent CHIKV infection in Anyigba. Therefore, there is need for routine screening of febrile patients and molecular characterization to determine the nature of circulating strains.